Elderly-onset Crohn’s disease remarkably responsive to ustekinumab: a case report

Abstract

Background Crohn's disease is intractable and is frequently diagnosed in younger people. No clear policies exist regarding medical treatment for seniors with this disease, and its diagnosis and treatment are often hindered by difficulties attributable to comorbidities, complex differential diagnoses, and polypharmacy. We describe an elderly-onset Crohn's disease patient showing a marked remission-maintaining effect with no adverse events after administration of ustekinumab. Methods and results A 75-year-old patient with Crohn's disease and a history of pulmonary tuberculosis had first presented to our hospital at age 64 years and was hospitalized. Based on physical examinations, colonoscopy, and blood test results, Crohn's disease was diagnosed. The patient experienced secondary losses of responsiveness to two tumor necrosis factor (TNF)-alpha inhibitors, and after repeated hospital admissions, she was administered ustekinumab. The patient's symptoms, endoscopic findings, Crohn's Disease Activity Index, serum albumin, and physical activity levels improved markedly, and disease remission has been maintained for 2 years to date. Conclusion Ustekinumab is an effective treatment option for elderly patients with intractable Crohn's disease when TNF-alpha inhibitors are ineffective.

Elderly Patients with Moderate-To-Severe Ulcerative Colitis Are More Likely to Have Treatment Failure and Adverse Outcome

“…Cheng et al [26] found that antitumor necrosis factor medication therapy did not bring about more increased risk of adverse events in old UC patients aged 60 years and over, including severe infections, hospitalization, or death. Also, recent studies have reported that new biological agents have satisfied effectiveness and safety in the treatment of elderly UC, such as vedolizumab or ustekinumab [27, 28].…”

“…The median age of onset in the elderly and nonelderly was also significantly different (62 [58-66] vss. 29 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39], p < 0.001). As shown in Table 1, at the first admission, dis-ease duration was similar around 3 years in these 2 groups.…”